“Speaking Up” for Patient Safety in the Pediatric Emergency Department

Communication breakdowns in high-risk areas such as emergency medicine and pediatrics impede care and threaten patient safety. A pervasive problem is the failure of clinicians to speak up with ideas, questions, or concerns. Honest lapses in communication occur with the distractions and interruptions of the emergency department despite the best intentions; in contrast, failures to speak up represent conscious choices to remain silent over giving voice to concerns. The complex socialization process in health care, authority gradients, and past experiences with disruptive and rude behavior influence clinicians from all professions when they weigh the risks and benefits of speaking up. Culture change at the organizational level and within clinical units will enhance the psychological safety that enables speaking up and promotes listening. Direct supervisors who engage in specific leadership behaviors foster a supportive workplace climate. Targeted communication strategies can help clinicians find their voice in the service of patient safety.